Provider Demographics
NPI:1750438719
Name:LISTUG-VAP, ANGELA D (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:LISTUG-VAP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:LISTUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:5000 BLUE MOUNTAIN RD.
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9213
Mailing Address - Country:US
Mailing Address - Phone:406-251-2323
Mailing Address - Fax:406-251-2999
Practice Address - Street 1:2965 STOCKYARD RD.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1557
Practice Address - Country:US
Practice Address - Phone:406-541-2606
Practice Address - Fax:406-541-2607
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19412251X0800X
CA322992251X0800X
OR46172251X0800X
WA96672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011000282Medicare PIN